DESCRIPTION: (Applicant's Description) The success of the effort to decrease colorectal cancer (CRC) mortality is limited by low rates of compliance with screening. Hereditary nonpolyposis colorectal cancer (HNPCC) is the most common cause of hereditary colon cancer. Intensive surveillance beginning at age 25 and/or prophylactic colectomy and annual endometrial cancer screening are recommended in at-risk family members. We have previously shown that surveillance and prophylactic colectomy lead to large gains in life-expectancy for HNPCC patients. However, there are no available data regarding screening compliance rates or use of prophylactic surgery in this high-risk population. In addition, our preliminary data suggest that many patients and physicians are not aware of the need for frequent and early colonoscopy and the need for surveillance for extracolonic tumors in HNPCC. The research projects outlined in this application address several of these factors. We propose to assess compliance with CRC and extracolonic tumor screening in 400 individuals from HNPCC families. Patients will be recruited from a variety of clinical practices ranging from primary care physicians to specialized cancer genetics clinics. We will develop a behavioral intervention that includes health care provider delivered messages, educational materials, reminder post-cards and motivational phone calls designed to educate HNPCC patients and promote screening compliance. HNPCC patients who have not undergone recommended colorectal and endometrial cancer screening will be enrolled in a randomized controlled pilot study of the standardized behavioral intervention compared to usual care. Cancer screening compliance and knowledge about HNPCC will then be compared between the usual care and intervention groups. If the intervention appears to be effective in this pilot study, we plan a future multi-center study using established HNPCC registries and co-operative groups. The structure of the intervention and educational materials developed for this study could easily be exported for use in the clinical setting. The research plan and educational curriculum outlined in this proposal and institutional support provided have been designed specifically for the candidate to develop expertise in cancer prevention research related to the genetics and prevention of gastrointestinal cancer and ensure an independent research career.